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ASD NON-HAZARDOUS WASTE MANIFEST <br /> F .W- WWASTE TREATMENT AND DISPOSAL FACILITY <br /> INC. J013 AGGf--P ANCE: NO, � 93 - 51111 - <br /> IN <br /> ERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 'F Lv�r�zcle Lrn <br /> ernt Coiopany ❑GLOVES [-]GOGGLES ❑RESPIRATOR QHARD HAT <br /> MAILING ADDRESS ❑TY-VEK ❑OTHER <br /> CIT 1P,rStATUlP 90G SPECIAL HANDLING PROCEDURES <br /> 01-if(o nil 13=1r, CA. 911 ( .?_Q <br /> PHONE <br /> i; CONTACT PERSON <br /> s .T 'F3ti 1;111 (];7,1 <br />;y SIGNATURE©F7AUTH IZED A ENT Tty & DATE <br /> 1 41r. <br />� <br /> WA__ST9 TYPE RECEIVING FACILITY <br />�� ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> DISPOSAL 501E ❑ 9999 SOUTH AUSTIN ROAD <br /> ❑ <br /> CONSTRUCTION SOIL ❑ ASH ASH <br />" ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982--4298 PHONE <br /> Pivor-rtiicte Cer,r�ftt Corupprty (209) 982- 1009 FAX <br /> CA <br /> s <br /> E NOTES TRUCK NUMBER <br /> i' JI.r11 1,hovpe 011, Inc. <br />` <br /> , ADDRESS 2-2C- <br /> - CITY, STATE, ZIP <br /> y! Lo,iL, CA 91-3>41-035( <br />"Jf LPHONE END DUMP BOTTOM DUMP TRANSFER <br /> OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN f DRUMS <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> S� <br /> Forward shall have no obligation to accept the waste if weather or other JCI <br />,r conditions impair the safe and effective disposal of the waste or if the waste DISPOSAL METHOD (TO BE COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the Landfill Forward shall use <br /> ii reasonable efforts to promptly notify Disposer of its inability to accept the DISPOSE BIO AERATE STOCKPILE 'OTHER <br /> waste for any reason If Forwards refusal to accept the waste is based on <br /> rr weather or other site conditions Forward shall notify the Disposer when site ❑ SOIL <br /> conditions are expected to change such that Forward will be able to accept <br /> R <br /> the waste ❑ SLUDGE <br /> o REMARKS <br /> NON-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER <br /> x <br /> ❑ WOOD <br /> f SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑ ASH <br /> ❑ OTHER <br /> 11, A II 1;f W NIADF [1111;H' 11 r 1 of i I ryn t i if lm( f I,v w 1 f, r Yf 1f r 1 r 1) Ar' <br /> I'IVAL * ANY UNSCI IEDULED LOADS ARE <br /> r <br /> 111 01 ' 1 14) , f I1rA1 ilr(irr n111111�ni i-rit i tlri', Hilt y 1i1-1 Ivt 1tlf r,t i-1 I,, 1.4 t-r 111)1 f u O,VITtI fllr- LANDrILL IIAIE DAY REFOf1E <br /> Ir, 1 1 lir r,i it r= ( AI L pfin) nn? 1-+fnn 7875 <br /> MANIFEST # <br /> ]FIA 1` ri,rlI; 'I < till) <br />